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Old Crystal Bay Road North
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0800 Old Crystal Bay Road North - 28-118-23-43-0010
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Backflow preventer test reports
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Last modified
8/22/2023 4:25:48 PM
Creation date
3/14/2018 2:08:30 PM
Metadata
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Template:
x Address Old
House Number
800
Street Name
Old Crystal Bay
Street Type
Road
Street Direction
North
Address
800 Old Crystal Bay Road North
Document Type
Misc
PIN
2811823430010
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Updated
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• <br /> &% NowMoth <br /> OON' ,m <br /> 1633 Eustis Street <br /> Saint Paul MN 55108-1219 BACKFLOW PREVENTER TEST REPORT 47152260 <br /> (651)645-0451 '�/ <br /> DATE: ` 37-0 - R V of <br /> alves <br /> Site Name: ORO, i /0/4' (e s Job# 361 _oa... <br /> t� <br /> . Site Address: 500 6 /t CP ,QQ� city: <br /> �� Rd 04'0 h 0 Zip code: <br /> Zo A. 05/OA .. Phone#: 15 —111q ` f3/ y <br /> Owner: • Phone it: <br /> Owner Address: City: <br /> Make and • <br /> Zp code: <br /> SIZE: SERIAL#: <br /> s 9O? QT • a `t . . PI 3 0 ' <br /> OF DEVICE: <br /> '/er (oo" I <br /> OF oEv�cE 4` <br /> SERNES WHAT , <br /> SYSTEM r `� 60 . <br /> Check valve#1 Check Valve#2 Pres.DX Pte,DiL Strom <br /> • <br /> Across#1 When Relief <br /> Tes! Checks <br /> Leaked Leaked <br /> Before Close - ._ PSI None O <br /> Repair <br /> 3 . $ ( ) <br /> : . <br /> Final <br /> Leaked <br /> • Test <br /> . . () Cl () — ._ Psl aria ( ) <br /> Used - -:ERtIFiCATIOR . <br /> hereby moi+the g data to be correct and that the tested device is functioning within the limits of the stands*. <br /> IRM NAME: NEWMECH CO.INC. - ADDRESS: 1633 EUSTIS STREET ST.PAUL MN.55108 <br /> Y: w x'11 C@ v jA erfy CERTIFICATION#: -7 6 i T PI : 651.645-0451 <br /> ATE - REMARKS: <br /> INSTALL - ST 0 Rpm') ORIGINAL INSTALLATION DATE ZO 0 <br /> - - - - DATE OF LAST REBUILD: 00.5--- <br /> PTR REV. i/7/04 <br />
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